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General NPI Number Information
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NPI Number | 1013151844
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Entity Type | Individual
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Provider Name | MS. TASNEEM T.M. FARUQUI-WILDMAN
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Gender | Female
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 13028 1ST AVE S
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City | BURIEN
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State | WA
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Zip | 98168-2621
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Country | US
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Telephone | 206-244-3006
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Fax |
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Provider Business Mailing Address
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Address Line | 602 WHITWORTH LN S
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City | RENTON
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State | WA
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Zip | 98057-2413
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Country | US
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Telephone | 415-271-5259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 60069118
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License Number State | WA
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